Endodontics

Lecture 4 ‫ﻣﺤﻤﺪ ﺭﺷﻴﺪ‬.‫ﺩ‬.‫ﺃ‬

Intracanal Instruments
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Classification of intracanal instruments

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They are divided into six groups:

Group I: Manually-operated instruments, such as barbed broaches and K-type and H-
type instruments.
Group II: Low-speed instruments with a latch-type attachment. Typical instruments
in this group are Gates-Glidden (GG) burs and Peeso reamers. They are typically used
in the coronal part of the canal and never used in a canal curvature.
Group III: Engine-driven nickel-titanium rotary instruments. They consist of a
rotating blade that can safely be operated in, and adapt itself to, curved root canals.
Most engine- driven instruments available today belong to this group.
Group IV: Engine-driven instruments that adapt themselves three-dimensionally to
the shape of the root canal. Like other nickel-titanium instruments, they adapt to the
shape of the root canal longitudinally but additionally they adapt also to the cross-
section of the root canal. There is currently only one instrument in this group: the self-
adjusting file (SAF).
Group V: Engine-driven reciprocating instruments.
Group VI: Ultrasonic instruments.

Group I: Manually-operated instruments

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Barbed Broaches
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They were the earliest endodontic instruments

used to extirpate the pulp. They are manufactured
by hacking a round, tapered wire with a blade to
form sharp, projecting barbs that cut or snag
tissue. A barbed broach does not cut or machine
dentin; this instrument is mostly used to engage and remove soft tissue from the canal.
It is an excellent tool for removing cotton or paper points that have accidentally
become lodged in the root canal.
K-type instruments.
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The K-file and K-reamer are the oldest useful

instruments for cutting and machining dentin.
They are made from a stainless steel wire that is
ground to a tapered square or triangular cross-
section and then twisted to create either a file or
a reamer. A file has more flutes per length unit
than a reamer. K-type instruments are useful for penetrating and enlarging root canals.
The instrument works primarily by compression- and-release destruction of the dentin
surrounding the canal. Generally, a reaming motion (constant file rotation) causes less
transportation than a filing motion. Transportation is the excessive loss of dentin from
the outer wall of a curved canal in the apical segment. As the instrument is increased
in width its flexibility is decreased.
K-flex file
It has a cross-section that is rhomboid in shape. It is a twisted instrument
and has a series of cutting flutes. It has 2 acute edges and 2 obtuse edges.
The acute angle cuts into the dentin while the obtuse angle provides more
area for debris collection and removal. The cutting efficiency and flexibility
is greater than the K-type file.
Flex-O-File
This instrument resembles the K-type file but it is triangular in cross-
section. There is better cutting
action and more room for the
debris, better flexibility and more
resistance to fracture. The tip of the
instrument is non cutting so no
apical ledge formation is possible.
Flex-R-file
The design of the tip of this
instrument eliminates the
possibility of ledge formation by removing the cutting surface of the tip's leading
edge. This guides the instrument in the canal rather than cut. It has a triangular cross-
section which increases its flexibility. It cuts more efficiently in anti-clockwise
motion and can be used for filing action.

H-type instruments.
An H-type instrument has spiral edges arranged to allow cutting only during a pulling
stroke. An example is a Hedström file. An H-
type instrument is better for cutting than a K-
type instrument, because it has a more
positive rake angle and a blade with a cutting
rather than a scraping angle. Bending a
Hedström file results in points of greater stress concentration than occurs with K-type
instruments. These concentration points can lead to the propagation of cracks and
fatigue failure. All H-type instruments are ground from a tapered blank. Hedström
files are formed by grinding a single continuous flute.

S-file (Uni-file)
This instrument is a ground S-shaped cross-section instrument. This is
stiffer than the Hedstrom file. The cutting mode may be with filing or
reaming action.
Traditional instruments modifications
1- Nickel titanium file.
Files made from nickel titanium showed greater elastic flexibility and resistance to
torsional fracture than stainless steel. This file has a non cutting tip and it tends to
maintain the curvature of the root canal.
2- Golden mediums
These instruments are a series of intermediate size instruments. They correspond in
size to halfway between standard ISO sizes and correspond to 12,17,22,27,32 and 37
in number.
3- Canal Master U
This hand instrument is used to prepare the apical third of the canal. It has a non
cutting pilot tip, 1 mm length cutting blade and a narrow parallel sided shaft. It is used
to allow for better cutting with more space for debris accumulation and further
removal. It reduces the possibility of ledge or transportation.

Group II: Low-Speed Rotary Instruments

Many types of rotary instruments are used during endodontic procedures. In addition
to conventional burs, burs with extended shanks for low-speed contra-
angle handpieces are useful for providing good visibility during deep
preparation of the pulp chamber. This is particularly important when
using an operating microscope when performing such procedures after
access to the pulp chamber has been achieved. Straight-line access to the
initial point of curvature can be accomplished using rotary instruments
such as Gates-Glidden burs and Peeso instruments. Use of these
instruments should be limited to the straight portion of the canal
preparation. The risk of perforation with these instruments is a
possibility. The risk of lateral cutting resulting in perforation is
lower with Gates-Glidden burs than with the Peeso drills. The
Peeso reamer is used mostly for post space preparation.

Group III: Rotary Instruments for Canal Preparation

Components of a file
1- The taper. It is expressed as the amount the file diameter increases each
millimeter along its working surface from the tip toward the file handle. for example,
a size #25 file with a #.02 taper would have a 0.27 mm diameter 1 mm from the tip, a
0.29 mm diameter 2 mm from the tip, and a 0.31 mm diameter 3 mm from the tip.
Some manufacturers express the taper in terms of percentage (e.g., a #.02 taper is a
2% taper).
2- The flute of the file. It is the groove in the working surface used to collect soft
tissue and dentin chips removed from the wall of the canal. The effectiveness of the
flute depends on its depth, width, configuration, and surface finish.
3- Helix angle. It is the angle the cutting edge forms with the long axis of the file.
It gathers debris collected in the flute from the canal. This angle is important for
determining which file technique to use.

4- If a file is sectioned perpendicular to its long axis,

the rake angle is the angle formed by the leading edge
and the radius of the file. If the angle formed by the
leading edge and the surface to be cut (its tangent) is
obtuse, the rake angle is said to be positive or cutting. If
the angle formed by the leading edge and the surface to
be cut is acute, the rake angle is said to be negative or
scraping.
5- The pitch of the file is the distance between a point on the leading edge and
the corresponding point on the adjacent leading edge. The smaller the pitch or the
shorter the distance between corresponding points, the more spirals the file has and
the greater the helix angle.

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Rotary Instrumentation systems using Nickel Titanium

ProFile system
The ProFile system was introduced in 1994.
ProFile instruments have increased tapers
compared with conventional hand instruments.
The tips of the ProFile Series 29 rotary
instruments had a constant proportion of
diameter increments (29%). Cross section of a
ProFile instrument has a U-shape design with
radial lands and a parallel central core. Lateral
views show a 20-degree helix angle, a constant
pitch, bullet- shaped noncutting tips and with a
neutral or slightly negative rake angle. This configuration facilitates a reaming action.
Debris is transported coronally and is effectively removed from the root canals. The
preferred speed is 275-325 rpm.

ProFile GT Files.
The Greater Taper (GT) file was introduced in
1994. This instrument also has the U-shape file
design. The instruments comes in four tapers
(0.06, 0.08, 0.10, and 0.12), and the maximum
diameter of the working part coronally is 1 mm.
The instruments have a variable pitch and an
increasing number of flutes in progression to the
tip; the apical instrument diameter is 0.2 mm.
Instrument tips are noncutting and rounded.

ProTaper Universal system.

The ProTaper system is based on another concept and composed of six instruments:
three shaping files and three finishing files. This set is increased by two larger
finishing files and a set designed for retreatment procedures. In cross section,
ProTaper shows a modified K-type file with sharp cutting edges and no radial lands;
this creates a stable core and sufficient flexibility for the smaller files. The cross
section of finishing files F3, F4, and F5 is slightly relieved for increased flexibility.
The difference in design of this system is the varying tapers along the instruments’
long axes. The three shaping files have tapers that increase coronally, and the reverse
pattern is seen in the five finishing files. Shaping files #1 and #2 have tip diameters of
0.185 mm and 0.2 mm, respectively, 14-mm-long cutting blades. The diameters of
these files at D14 are 1.2 and 1.1 mm, respectively. The finishing files (F1-F5) have
tip diameters of 0.2, 0.25, 0.3, 0.4, and 0.5 mm, respectively, between D0 and D3, and
the apical tapers are .07, .08, .09, .05, and .04, respectively. The finishing files have
rounded noncutting tips.
The convex triangular cross section of
ProTaper instruments reduces the contact
areas between the file and the dentin. The
greater cutting efficiency of this design has
been improved by balancing the pitch and
helix angle, preventing the instruments from
threading into the canal. ProTaper instruments
can be used with 250 to 300 rpm.
Two usage characteristics are recommended
for the ProTaper system:
1-The preparation of a glide path.
2- The use of a more lateral “brushing”
working stroke. Such a stroke allows the
clinician to direct larger files coronally away from danger zones and counteract any
“threading-in” effect.

RaCe, Bio Race

The RaCe was manufactured since 1999 by FKG.
The name stands for reamer with alternating cutting
edges. This design aimed at reducing the tendency to
thread the file into the root canal. Cross sections are
triangular or square for #.02 instruments with size
#15 and #20 tips. The surface quality of RaCe
instruments is done by electropolishing. The tips are

round and noncutting.

Twisted File.
In 2008, the first fluted NiTi file was introduced and
manufactured by plastic deformation, a process
similar to the twisting process that is used to produce
stainless steel K-files. This is done when a thermal
process allows twisting during a phase transformation
into the “R-phase” of nickel-titanium. The instrument
is available with size #25 tip sizes only, in taper .04 up to .12. This production process
resulted in superior physical properties.

Wave One single file reciprocating system

This system is a single-use, single file system to shape
the root canal. In most cases, the technique only
requires one hand file followed by one single Wave
One file to shape the canal completely using the
reciprocation motion. The file is made with M-wire
technology which improves strength and resistance to cyclic fatigue about four times
the traditional rotary NiTi files. The system is composed of:
- The Wave One small file. It is used in narrow canals. The tip has an ISO of 20
with a continuous taper of 6%.
- The Wave One primary file. It is used in the majority of canals. The tip has an
ISO of 25 with an apical taper of 8% that reduces towards the coronal end.
- The Wave One large file. It is used in wide canals. The tip has an ISO of 40
with an apical taper of 8% that reduces towards the coronal end.
The instruments are designed to work with a reverse cutting action. All instruments
have a modified convex triangular cross section at the tip end and a convex triangular
cross section at the coronal end. This design improves instrument flexibility. The
variable pitch flutes along the length of the instrument improve safety.

ProTaper Next
This system is composed of 5 files, namely X1, X2, X3, X4 and
X5. These files correspond to sizes 20/04, 25/06, 30/07, 40/06 and
50/06 respectively. The X1 and X2 have variable tapered design
whereas X3-X5 files have a fixed taper from D1-D3 then a
decreasing percentage tapered design over the rest of their active
portions.
This system has a rectangular cross section that is of centered
which allows 2 points contact with the dentin wall and the rest of
the space free for storing debris which will be removed by the file
swaggering motion.

Group IV: Engine-Driven Three-Dimensionally

Adjusting Files (Self-adjusting file)
The self-adjusting file (SAF) represents a new approach in file design
and mode of operation. The file is a hollow device, designed as a
cylinder of thin-walled, delicate NiTi lattice with a lightly abrasive
surface. An initial glidepath is established with a #20 K-file to allow
the insertion of the SAF file. The file is proposed to be compressed
from its 1.5 mm diameter into dimensions equivalent to those of a #25
K-file. The handpiece generates in-and-out vibrations with 5000
vibrations per minute and 0.4 mm amplitude. The compressed file will
adapt itself to the root canal walls, applying a uniform cutting action
gradually removing a uniform dentin layer from the canal walls. There a continuous
flow of irrigant which removes the tissue debris and the dentin powder generated by
the file.

Group V: Engine-Driven Reciprocating Instruments: Endo-eze

reciprocating files
The Giromatic handpiece, a rotary instrument in use since 1969, delivers 3000
quarter-turn reciprocating movements per minute. Rasps and barbed broaches are
most often used in Giromatic handpieces, but K-type and H-type instruments also can
be used. The endo-eze file system (Ultradent) is a recently introduced addition for
Giromatic handpieces. The set has four instruments that are designed to clean the
middle third of the canal. The sizes and tapers are 0.10 #0.025 taper, 0.13 #0.35 taper,
0.13 #0.45 taper and 0.13 #0.06 taper. The use of stainless steel hand instruments is
suggested for the apical third of the canal.

Group VI: Sonic and Ultrasonic Instruments

A very different way of instrumenting root canals was introduced when files or
ultrasonic tips (of different shapes and sizes) were activated by electromagnetic
ultrasonic energy. Piezoelectric ultrasonic units are also available for this
purpose. These units activate an oscillating sinusoidal wave in the file
with a frequency of about 30 kHz.
Two types of units, ultrasonic and sonic, are primarily available.
Ultrasonic devices, which operate at 25 to 30 kHz, include the
magnetostrictive (Cavi-endo), and the piezoelectric (Enac). Sonic devices
operate at 2 to 3 kHz (Sonic Air MM 1500) Ultrasonic devices use
regular types of instruments (e.g., K-files), whereas sonic devices use
special instruments known as Rispi-Sonic, Shaper- Sonic, Trio-Sonic, or
Heli-Sonic files.
Although similar in function, piezoelectric units have some advantages over the
magnetostrictive systems. For example, piezoelectric devices generate little heat, so
no cooling is needed for the electric handpiece. The magnetostrictive system
generates considerable heat, and a special cooling system is needed in addition to the
irrigation system for the root canal.
The file in an ultrasonic device vibrates in a sinus wave–like fashion. A standing
wave has areas with maximal displacement (i.e., antinodes) and areas with no
displacement (i.e., nodes). The tip of the instrument exhibits an antinode. Files must
be used only for a short time, must remain passive within the canal, and the power
must be controlled carefully.
Ultrasonic devices have proved very efficient for irrigating root canal systems.
During free ultrasonic vibration in a fluid, two significant physical effects are
observed: cavitation and acoustic streaming. During oscillation in a fluid, a positive
pressure is followed by a negative pressure causing implosion. This is cavitation.
Acoustic streaming creates small, intense, circular fluid movement around the
instruments.